Rehabilitation needs and activity limitations of adults with a visual impairment entering a low vision rehabilitation service in England

Purpose- To evaluate outcome measures of the Participation and Activity Inventory (PAI) in a sample of adults with acquired visual impairment entering vision rehabilitation. Both Priority Scores, indicating level of rehabilitative need, and Person Measures, indicating goal difficulty, were considered. Methods- Participants were newly registered adults with visual impairment within Leicestershire, United Kingdom. The importance and difficulty of 48 goals of the PAI were assessed, as were demographic factors, clinical visual function (visual acuity, contrast sensitivity, reading function) and psychosocial function (adjustment to visual loss, depression, anxiety and fear of falling). Priority scores were calculated as the product of importance and difficulty of each goal. All questionnaires were Rasch analysed, and person and item measures of perceived difficulty with goals were derived. Results- Sixty people (mean age ± S.D. = 75.8 ± 13.8 years) took part. PAI goals with greatest rehabilitative need were reading (6.82 ± 2.91), mobility outdoors (6.55 ± 3.92), mobility indoors within an unfamiliar environment (5.52 ± 3.93) and writing (5.27 ± 3.02). Greater rehabilitative need was associated with younger age (β = −0.46, p < 0.001), and with higher depressive symptomatology (β = 0.35, p < 0.01; model R2 34%). Goals with greatest difficulty were mending clothing (−1.95 ± 0.35 logits) and hobbies and crafts (−1.32 ± 0.23 logits). Greater difficulty was associated with higher depressive symptomatology (β = 0.39, p < 0.001), lower visual acuity (β = 0.42, p < 0.001) and lower adjustment of visual loss (β = 0.31, p < 0.01; model R2 53%). Conclusions- Key rehabilitation needs for adults at entry to services require both optical and non-optical interventions. As rehabilitative need was not associated with the level of visual impairment, eyecare professionals should not wait until the end of medical treatment before referral for support. Similarly, rehabilitative need was associated with younger age, indicating the importance to refer younger people with sight loss at an early stage. The use of structured assessment, such as the PAI, ensures goals that have an impact upon quality of life are specifically identified. Depression screening on entry to rehabilitation is relevant as it predicts both perceived difficulty and rehabilitative need

How effective is low vision service provision? A systematic review

Visual impairment is a large and growing socioeconomic problem. Good evidence on rehabilitation outcomes is required to guide service development and improve the lives of people with sight loss. Of the 478 potentially relevant articles identified, only 58 studies met our liberal inclusion criteria, and of these only 7 were randomized controlled trials. Although the literature is sufficient to confirm that rehabilitation services result in improved clinical and functional ability outcomes, the effects on mood, vision-related quality of life (QoL) and health-related QoL are less clear. There are some good data on the performance of particular types of intervention, but almost no useful data about outcomes in children, those of working age, and other groups. There were no reports on cost effectiveness. Overall, the number of well-designed and adequately reported studies is pitifully small; visual rehabilitation research needs higher quality research. We highlight study design and reporting considerations and suggest a future research agenda

The relationship between low vision, depression, and functional disability in the elderly

This study examined the relationship between low vision, depression and functional disability among 70 elderly patients that attended the Low Vision Clinic at Wills Eye Hospital. It was hypothesized that: (1) increased severity of visual impairment is associated with a diagnosis of depression and with increased severity of depression; (2) increased severity of visual impairment is associated with higher levels of functional impairment; (3) diagnosis of depression and increased severity of depression is associated with increased levels of functional impairment; and (4) for any given level of visual impairment, a diagnosis of depression exerts an independent, negative effect on functional capacity. Severity of depression was measured by the Geriatric Depression Scale (GDS), and diagnosis of depression was measured by the DSM-III-R criteria for diagnosis of depressive disorder. Functional impairment was measured by the functional assessment scale. Part of the interview of each subject was a Low Vision Depression Screen, that was designed specifically for this study. Visual impairment was determined by an ophthalmologist. No statistical differences were found in visual impairment between patients with depressive disorder and non-depressed patients. However, severity of visual impairment was highly correlated with a diagnosis of depression among patients with depressive disorders. There was a correlation between severity of visual impairment and severity of functional impairment. In particular, a very strong correlation was found between severity of depressive symptoms and functional impairment among the non-depressed patients. The most powerful variable that was associated with functional impairment was severity of depression (Adj R\sp2 =.20; P $\u3c$.0001). Number of medications, contributed cumulatively 30%. Finally, severity of depression, number of medications, and severity of visual impairment cumulatively explained 37% of the variance related to functional impairment. For any given level of visual impairment, a diagnosis of depressive disorder was found to exert an independent negative effect on functional capacity. The above results are discussed in light of previous research. Limitations of this study are also discussed, and the possible impact of these limitations on the results is assessed. Finally, suggestions for future research are presented based on the methodology and results of the current study